Dana Janczak listens to her 10-year-old son Nathanael's chest after his pulmicort treatment in their rural Cleveland home. Janczak said she and her children suffer from asthma and find access to a doctor difficult.

Photo: Mayra Beltran, Chronicle

Dana Janczak listens to her 10-year-old son Nathanael's chest after...

From Dana Janczak's home in a secluded rural area east of Cleveland, it's a 40-mile ride to the nearest asthma doctor in Kingwood, so she tries to keep trips to a minimum by stocking up on nebulizers: four in her house and two in her car.

Janczak is one of 25 million Americans who suffer from asthma, but what distinguishes her and other rural residents in the Houston region — which has the highest prevalence of asthma in Texas — is that, despite her best efforts, she still has ended up in the hospital three times.

A Houston Chronicle analysis of state health records found that rural Cleveland in Liberty County has the highest rate of hospitalization for asthma-related conditions in the 10-county region. In the Houston area overall, nearly 10,000 people were hospitalized between 2007 and 2009 for asthma, according to data provided by the Texas Department of State Health Services.

"We had to live in the ER for a while," Janczak recalls of her most serious attack in 2007. "I felt like my airway was closed. I heard my husband's voice was getting farther and farther away."

Liberty County health professionals say several factors contribute to the elevated hospitalization rate, such as a high percentage of smokers and the fact that much of the area is densely covered by woods and their naturally aggravating allergens. But the primary factor, they say, is likely the lack of access to medical care.

Other rural areas such as Coldspring and Shepherd in San Jacinto County also had significantly elevated hospitalization rates. Experts attribute that mainly to one thing: Urban areas, with more health care options, are better equipped to treat the respiratory disease that kills almost 4,000 people and puts 456,000 Americans in hospitals every year.

"(Asthma) specialty services are really concentrated in urban areas," said Dr. William Calhoun, a lung disease professor at the University of Texas Medical Branch in Galveston. "In Central and West Texas, up to the Panhandle, there are entire counties that don't have pulmonary or allergy specialists."

Income also a factor

Uniformly, though, the areas in the greater Houston region that also have elevated hospitalization rates for asthma are all in pockets where the median household income is lower than the average.

Sunnyside, mere miles from the Texas Medical Center and its dense knot of top-notch medical clinics, ranked second-highest in its hospitalization rate in the Chronicle analysis. With a household median income level of $17,000, however, it is much poorer than the rest of Harris County where the median income is nearly $43,000, suggesting poverty may be the greatest single contributor.

Even when they do seek medical care, a new study shows poorer residents may have a harder time getting it. Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists, according to the study in The New England Journal of Medicine. They often had to wait more than a month for an appointment, even for serious medical problems such as asthma.

Generally, the east side of Houston - with the Ship Channel and an array of oil refineries - has a higher rate of asthma hospitalizations than the west.

North Pasadena, La Porte, Highlands and Baytown - which are all along the Ship Channel - have higher than average rates. So do La Marque and west Texas City, near the oil and gas facilities in Galveston County.

"You're right in the road of refineries and that is a very significant source of pollution, and pollution is documented to trigger asthma," said Dr. Harold Farber, a professor and pediatrician at Texas Children's Hospital. "I know some pediatricians have said when the wind from the refineries is blowing in our direction, you get more kids coming into the office with asthma."

Environmental factors

Medical research shows that environmental factors can trigger asthma attacks, including air pollution, secondhand smoke, dust mites and even cockroach allergens. The Centers for Disease Control and Prevention says that higher levels of the ozone pollutant is a significant risk to asthma patients, and the Houston region is classified as being in "severe nonattainment" by EPA standards.

Vince DeLaHoz has had asthma for more than 20 years. His symptoms worsened and became more frequent after he moved to Houston from El Paso. He is a house inspector for an insurance company in the Pasadena area, adjacent to the Ship Channel.

"I have to go outdoors near the plants. The smell from the plants hurts my lungs. I can just feel it," said DeLaHoz.

Nationwide increase

The CDC says the asthma rate has been increasing steadily over the past decade: while about 20 million people, or 7 percent of the population, had asthma in 2001, 25 million had it in 2009.

In 2007, the total charges for asthma hospitalizations in Texas were more than $446 million, according to the report conducted in 2009 by the state health department. While a third of that is paid by private insurance firms, more than half falls to Medicare and Medicaid.

The state has launched education programs to bring awareness of the importance of preventative health care - and to help control costs in an age of austerity.

"Children with asthma are going to be much healthier if we get them into regular care and help them manage their condition," said Stephanie Goodman, the spokeswoman for the Texas Health and Human Services Commission. "That also helps lowers the cost to the state because they're less likely to need emergency room care or hospitalization."